AB0309 CLINICAL EFFICACY AND SAFETY OF TOFACITINIB COMBINED WITH IGURATIMOD FOR RHEUMATOID ARTHRITIS-ASSOCIATED USUAL INTERSTITIAL PNEUMONIA
Authors: W. Xie, S. Wang, Y. Li, Y. Tang
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Research has found that iguratimod(IGU) could be an effective therapeutic strategy for pulmonary fibrosis<sup>[1-3]</sup>.The results of the Vitro and in vivo studies indicated that tofacitinib(TOF),slowing the progression of ILD associated with connective tissue diseases,is a potential therapeutic option for rheumatoid arthritis with usual interstitial pneumonia(RA-UIP)<sup>[4-7]</sup><sub>.</sub> <h3>Objectives</h3> This study aimed to investigate the efficacy and safety of TOF plus IGU in RA-UIP. <h3>Methods</h3> This was a prospective observational cohort,single-center study.Data were analyzed from 52 RA-UIP patients.24 were treated with TOF(5mg twice daily) plus IGU.28 were treated with Methotrexate(MTX)/Leflunomide(LEF) plus conventional synthetic disease-modifying anti-rheumatic drugs(csDMARDs).A clinically relevant response was defined as a decrease in disease activity score 28-joint count CRP(DAS28-CRP) score and high-resolution computed tomography(HRCT) scores from baseline.Deterioration and regression were respectively defined by an increase or decrease of at least 10% of the overall disease extent according to HRCT,whereas changes of less than 10% defined stability.Clinical indicators were compared between the two groups to evaluate the efficacy. <h3>Results</h3> A total of 24 RA-UIP patients treated with TOF plus IGU and 28 treated with MTX/LEF plus csDMARDs were enrolled and followed up for 6 months.The DAS28-CRP of the TOF plus IGU group was significantly lower than baseline(4.8±1.6vs.3.8±1.9),but there was no significant difference compared with the MTX/LEF plus csDMARD group(P=0.762).The FVC% was significantly improved after 6 months of TOF plus IGU treatment;the change from baseline was more significant than the MTX/LEF plus csDMARD group(-1.89±2.33,P=0.031).TOF plus IGU group had a significantly HRCT fibrosis scores improvement(-0.17±2.52)than the MTX/LEF plus csDMARD group(1.36±2.42,P=0.038)(<b>Table 1</b>).In the TOF plus IGU group,8 patients(8/24,33.3%) showed RA-UIP deterioration,6 patients(6/24,25.0%) were considered stable,and 10 patients(10/24,41.7%) demonstrated regression.In the MTX/LEF plus csDMARD group,18 patients(18/28,64.3%) showed deterioration,6 patients(6/28,21.4%) were stable,and 4 patients(4/28,14.3%) demonstrated RA-UIP regression.TOF plus IGU-treated group had a significantly higher response(regression + stability) than MTX/LEF plus csDMARD-treated group,66.7%(16/24) vs.33.5%(10/28)(P=0.008),respectively. <h3>Conclusion</h3> Our results indicated that TOF plus IGU could simultaneously relieve RA and RA-UIP,and be better than the MTX/LEF plus csDMARDs with a higher response rate in RA-UIP,which may be a potential choice for dual treat-to-target. <h3>References</h3> [1]Zhao L,Mu B,Zhou R,et al.INT J RHEUM DIS 2019;22:686-94. [2]Jiang H,Gao H,Wang Q,et al.BIOMED PHARMACOTHER 2020;122:109704. [3]Han Q,Zheng Z,Liang Q, et al.INT IMMUNOPHARMACOL 2021;97:107596. [4]Vacchi C,Manfredi A,Cassone G,et al.Case Reports in Medicine 2021;2021:1-5. [5]Sendo S,Saegusa J,Yamada H,et al.ARTHRITIS RES THER 2019;21:184. [6]Lescoat A,Lelong M,Jeljeli M,et al.BIOCHEM PHARMACOL 2020;178:114103. [7]Tardella M,Di Carlo M,Carotti M,et al.INFLAMMOPHARMACOLOGY 2022;30:705-12. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.